Gunshot injuries in children result in a disproportionate share of severe and costly medical outcomes. / Justin Sullivan, Getty Images

by Michelle Healy, USA TODAY

by Michelle Healy, USA TODAY

Gunshot-related injuries are well known as a leading cause of death among children and adolescents, but other aspects of the health toll they inflict get much less attention, including injury severity, the need for major surgical intervention, and high care costs, a new study says.

The burden of these adverse outcomes is particularly common for older adolescent males (ages 15 to 19), who accounted for the majority (83.2%) of children who suffered gunshot injuries in the study reported in November's Pediatrics, published online today.

"If we focus on just fatalities, we're only looking at the tip of the iceberg," says Newgard, associate professor and director of the Center for Policy and Research in Emergency Medicine at the Oregon Health & Science University in Portland.

According to the Centers for Disease Control and Prevention, gunshot injuries rank second only to motor vehicle crashes as a cause of death for children ages 15 to 19. From 2001 to 2010, 29,331 children ages 0 to 19 years died of gunshot-related injuries; another 155,000 were injured seriously enough to undergo treatment in emergency departments.

In the new study, researchers analyzed data collected over three years on 49,983 kids and teens evaluated by emergency medical service (EMS) agencies transporting to 93 hospitals in five regions of the West - Portland, Ore./Vancouver, Wash. (four counties); King County, Wash.; Sacramento (two counties); Santa Clara, Calif. (two counties); and Denver County, Colo.

Gunshot wounds accounted for just 1% of injured children but were associated with 21% of deaths after injury.

Although the rate of gunshot-related injuries (8 per 100,000 children) was "relatively small" compared with six other causes of injuries studied (including cuts, falls and motor vehicle crashes), they had dramatically higher adverse outcomes.

Specifically, children wounded by gunshots had the highest proportion of serious injuries (23%), major surgeries (32%) and deaths in hospitals (8%), along with the highest acute care costs, $28,510 per patient. The next highest care costs, $15,566, were for injuries sustained from being struck by a motor vehicle.

"In every metric that we looked at, the front-runner far and away for worst outcome and greatest impact was gunshot-related injuries," says Newgard.

Given that the data used represents just five regions of the western part of the country, the findings likely underestimate the national picture, he adds.

Overall, "The study highlights the highly lethal nature of firearm-related injuries among children," says Patrick Carter, an emergency physician and injury researcher at the University of Michigan Injury Center in Ann Arbor. Carter was not involved in the new study.

It also reinforces the need for additional research into effective approaches to reduce individual and environmental risk factors along with effective public health interventions, Carter says.